Liverpool Care Pathway - The Outsiders And The Also-rans

The winner is the one that will see it through to the end...





This is the Grampian Integrated Palliative Care Plan version 7 (31st January 2012) -

The aim of the Grampian integrated palliative care plan is to help clinicians provide quality palliative care to patients, no matter their diagnosis or location, by building on the established Gold Standards Framework. Its key aim is to provide a framework that can be used with existing documentation.

The GIPCP incorporates both aspects of the GSF and the SPICT -

- SPICT

The SPICT has its own website which depicts a watermarked June 2013 version. This has been edited in the following manner from the July 2012 version:

Eating less; difficulty maintaining nutrition.
…………Choosing to eat and drink less; difficulty maintaining nutrition

Unable to communicate meaningfully; little social interaction.
…………No longer able to communicate using verbal language; little social interaction.

Kidney failure due to another life limiting condition or treatment.
…………Kidney failure complicating other life limiting conditions or treatments.

Has needed ventilation for respiratory failure. 
…………Has needed ventilation for respiratory failure or ventilation is contraindicated.

SPICT is a trademark of the University of Edinburgh and NHS Lothian but it was not found to be registered at the Intellectual Property Office.

The unwatermarked July 2012 version SPICT is still available online.

SPICT 23-01-12

The January 2012 version which is illustrated in the GIPCP differs more substantially from its scions. This version bears no TM claim.

It actually quotes and recommends to ask the GSF/Barton Surprise Question. Hence, no copyright...

It also recommends to look for two or more 'clinical indicators'.

The scions recommend to look for ANY 'clinical indicator'.

SPICT July 2012

SPICT June 2013

An interesting NHS Grampian document is Living and Dying Well: Building on Progress. Progress Report - October 2011. NHS Grampian. This refers to the Scottish Government programme, Living and Dying Well, rolled out in October 2008. Initially, the GSF is being recommended, and is acknowledged...

Reproduced with permission from the Gold Standards Framework Centre. Prognostic Indicator Guidance Paper. England 2005: September 2008

Perhaps, as the nationalist sentiment has become more assertive, it was desired to ditch this and create a Scottish GSF - The SPICT!

This is from the NHS Grampian document -

As Living and Dying Well is rolled out in all care settings, SPICT and its use will be encouraged. It will also be included in the ward based resource and its use will be the subject of future audit.

Interestingly, a search on the Scottish Government Riaghaltas na h-Alba webpage for SPICT finds the version 12, December 2010 document. This bears no TM and relies on the GSF/Barton Surprise Question.

The SPICT was in development from 2010 and, by the end of the year, was already in version 12...

The non-runners, like Principles of Care from LCA, are intended to be...

suitable for all dying patients, whatever their illness. This is in response to the recently published review of the Liverpool Care of the Dying Pathway (LCP), which recommended phasing out the LCP.

Courses have been put together like this one from ModernGov -

Baroness Nueberger, Author of the More Care, Less Pathway: A review of the Liverpool CAre Pathway - Invited
- Learn from the lessons of he Liverpool Pathway, which led to controversial treatment of patients
- Understand the greater freedoms given to hospitals: can create their own pathways
- Develop the most effective palliative care for your patients

- Dignity in End of Life Care. Improve Your Care Pathway

The Royal Marsden organised a lucrative get-together at £120 a time. It was an 

opportunity to meet and network with professional colleagues from a range of working environments. 

As the hare learned from the tortoise, the winner is not the fastest runner, but the one who will see it steadfastly through to the finish.

Dr. Bee Wee...?

Further reading -

Liverpool Care Pathway - The Pathway Is Legion